Psoriatic arthritis
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Overview
| Psoriatic arthritis Classification and external resources | |
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|---|---|
| Psoriatic arthritis. Note to asymmetrical and advanced articular deformations. | |
| ICD-10 | L40.5, M07. |
| ICD-9 | 696.0 |
Click here for The Heart in Psoriasis
Psoriatic arthritis (also arthropathic psoriasis or psoriatic arthropathy)) is a type of inflammatory arthritis that affects around 5-7% (according to Oxford Handbook of Clinical Medicine) of people suffering from the chronic skin condition psoriasis. Psoriatic arthritis is said to be a seronegative spondyloarthropathy and therefore occurs more commonly in patients with tissue type HLA-B27. Treatment of psoriatic arthritis is similar to that of rheumatoid arthritis. More than 80% of patients with psoriatic arthritis will have psoriatic nail lesions characterised by pitting of the nails, or more extremely, loss of the nail itself (onycholysis).
Psoriatic arthritis can develop at any age, however on average it tends to appear about 10 years after the first signs of psoriasis. For the majority of people this is between the ages of 30 and 50, but it can also affect children. Men and women are equally affected by this condition. In about one in seven cases the arthritis symptoms may occur before any skin involvement.
As well as causing joint inflammation, psoriatic arthritis can cause tendinitis and a sausage-like swelling of the digits known as dactilytis. Radiology will give the appearance of "fluffy, new" bone.
Types of psoriatic arthritis
There are five main types of psoriatic arthritis:
- Symmetric: This type accounts for around 50% of cases, and affects joints on both sides of the body simultaneously. This type is most similar to Rheumatoid arthritis and is disabling in around 50% of all cases.
- Asymmetric: This type affects around 35% of patients and is generally mild. This type does not occur in the same joints on both sides of the body and usually only involves less than 3 joints.
- Arthritis mutilans (M07.1): Affects less than 5% of patients and is a severe, deforming and destructive arthritis. This condition can progress over months or years causing severe joint damage.
- Spondylitis (M07.2): This type is characterised by stiffness of the spine or neck, but can also affect the hands and feet, in a similar fashion to symmetric arthritis.
- Distal interphalangeal predominant (M07.0): This type of psoriatic arthritis is found in about 5% of patients, and is characterised by inflammation and stiffness in the joints nearest to the ends of the fingers and toes. Nail changes are often marked.
Diagnosis
Radiographs of the hands demonstrate psoriatic arthritis
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Treatments
The underlying process in psoriatic arthritis is inflammation, therefore treatments are directed at reducing and controlling inflammation. NSAIDs such as diclofenac and naproxen are usually the first line medication.
Other treatment options for this disease include joint injections with corticosteroids - this is only practical if a few joints are affected.
If acceptable control is not achieved using NSAIDs or joint injections then second line treatments with immunosuppressants such as methotrexate are added to the treatment regimen. An advantage of immunosuppressive treatment is that it also treats the psoriasis in addition to the arthropathy.
Recently, a new class of therapeutics developed using recombinant DNA technology called Tumor necrosis factor-alpha inhibitors have come available, for example, infliximab, etanercept, and adalimumab. These are becoming increasingly commonly used but are usually reserved for the most severe cases. As more is learned regarding the long-term safety of these biologic agents there is a trend toward earlier use to prevent irreversible joint destruction.
External links
- National Psoriasis Foundation
- Psoriasis Cure Now nonprofit advocacy group
- National Institutes of Health entry on psoriatic arthritis
- Psoriatic Arthritis
Diseases of the musculoskeletal system and connective tissue (M, 710-739) | |
|---|---|
| Arthropathies | Arthritis (Septic arthritis, Reactive arthritis, Rheumatoid arthritis, Psoriatic arthritis, Felty's syndrome, Juvenile idiopathic arthritis, Still's disease) - crystal (Gout, Chondrocalcinosis) - Osteoarthritis (Heberden's node, Bouchard's nodes)
acquired deformities of fingers and toes (Boutonniere deformity, Bunion, Hallux rigidus, Hallux varus, Hammer toe) - other acquired deformities of limbs (Valgus deformity, Varus deformity, Wrist drop, Foot drop, Flat feet, Club foot, Unequal leg length, Winged scapula) patella (Luxating patella, Chondromalacia patellae) Protrusio acetabuli - Hemarthrosis - Arthralgia - Osteophyte |
| Systemic connective tissue disorders | Polyarteritis nodosa - Churg-Strauss syndrome - Kawasaki disease - Hypersensitivity vasculitis - Goodpasture's syndrome - Wegener's granulomatosis - Arteritis (Takayasu's arteritis, Temporal arteritis) - Microscopic polyangiitis - Systemic lupus erythematosus (Drug-induced) - Dermatomyositis (Juvenile dermatomyositis) - Polymyositis - Scleroderma - Sjögren's syndrome - Behçet's disease - Polymyalgia rheumatica - Eosinophilic fasciitis - Hypermobility |
| Dorsopathies | Kyphosis - Lordosis - Scoliosis - Scheuermann's disease - Spondylolysis - Torticollis - Spondylolisthesis - Spondylopathies (Ankylosing spondylitis, Spondylosis, Spinal stenosis) - Schmorl's nodes - Degenerative disc disease - Coccydynia - Back pain (Radiculopathy, Neck pain, Sciatica, Low back pain) |
| Soft tissue disorders | muscle: Myositis - Myositis ossificans (Fibrodysplasia ossificans progressiva)
synovium and tendon: Synovitis/Tenosynovitis (Calcific tendinitis, Stenosing tenosynovitis, Trigger finger, DeQuervain's syndrome) - Irritable hip - Ganglion cyst bursa: bursitis (Olecranon, Prepatellar, Trochanteric) - Baker's cyst fibroblastic disorders (Dupuytren's contracture, Plantar fasciitis, Nodular fasciitis, Necrotizing fasciitis, Fasciitis, Fibromatosis) shoulder lesions: Adhesive capsulitis - Rotator cuff tear - Subacromial bursitis enthesis: enthesopathies (Iliotibial band syndrome, Achilles tendinitis, Patellar tendinitis, Golfer's elbow, Tennis elbow, Metatarsalgia, Bone spur, Tendinitis) other, NEC: Muscle weakness - Rheumatism - Myalgia - Neuralgia - Neuritis - Panniculitis - Fibromyalgia |
| Osteopathies | disorders of bone density and structure: Osteoporosis - Osteomalacia - continuity of bone (Pseudarthrosis, Stress fracture) - Monostotic fibrous dysplasia - Skeletal fluorosis - Aneurysmal bone cyst - Hyperostosis - Osteosclerosis Osteomyelitis - Avascular necrosis - Paget's disease of bone - Algoneurodystrophy - Osteolysis - Infantile cortical hyperostosis |
| Chondropathies | Juvenile osteochondrosis (Legg-Calvé-Perthes syndrome, Osgood-Schlatter disease, Köhler disease, Sever's disease) - Osteochondritis - Tietze's syndrome |
| See also congenital conditions (Q65-Q79, 754-756) | |
fr:Psoriasis#Arthrite psoriatique no:Psoriasis artritt
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Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
